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J Thorac Cardiovasc Surg 2008;136:834-841
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

The short esophagus: Intraoperative assessment of esophageal length

Sandro Mattioli, MDa,*, Maria Luisa Lugaresi, MD, PhDa, Mario Costantini, MDb, Alberto Del Genio, MDc, Natale Di Martino, MDd, Landino Fei, MDe, Uberto Fumagalli, MDf, Vincenzo Maffettone, MDc, Luigi Monaco, MDd, Mario Morino, MDg, Fabrizio Rebecchi, MDg, Riccardo Rosati, MDf, Mauro Rossi, MDh, Stefano Santi, MDh, Vincenzo Trapani, MDe, Giovanni Zaninotto, MDb

a Division of Esophageal and Pulmonary Surgery Villa Maria Cecilia e San Pier Damiano Hospitals, University of Bologna, Bologna, Italy
b Department of Surgical Sciences and Gastroenterology, University of Padova, Padova, Italy
c First Division of General and Gastrointestinal Surgery, II University of Naples, Naples, Italy
d VIII Division of General Surgery and Gastroenterologic Physiopathology, II University of Naples, Naples, Italy
e Unit of Gastrointestinal Surgery, School of Medicine, II University of Naples, Naples, Italy
f Esophagogastric Surgery Unit, Istituto Clinico Humanitas, Rozzano, University of Milan, Milan, Italy
g Minimally Invasive Surgery Centre, University of Turin, Turin, Italy
h General Surgery IV, Regional Referral Centre for Esophageal Pathology, Department of Medical and Surgical Gastroenterology, AOU Pisana, Pisa, Italy

Received for publication December 21, 2007; revisions received April 28, 2008; accepted for publication June 15, 2008.

* Address for reprints: Sandro Mattioli, MD, FECTS, FACS (Th), Università degli Studi di Bologna, Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Organo, Via Massarenti 9—40138 Bologna, Italy. (Email: sandro.mattioli{at}unibo.it).

Objective: To define the frequency and predictors of short esophagus in a case series of patients undergoing antireflux surgery.

Method: An observational prospective study from September 10, 2004, to October 31, 2006, was performed at 8 centers. The distance between the esophagogastric junction as identified by intraoperative esophagoscopy and the apex of the diaphragmatic hiatus was measured intraoperatively before and after esophageal mediastinal dissection; a distance of 1.5 cm was arbitrarily determined to categorize cases as long (>1.5 cm) or short (≤1.5 cm).

Results: One hundred eighty patients were enrolled; the mean age of patients was 49.3 ± 15.3 years. At the first measurement (after isolation of the esophagogastric junction), the median distance between the esophagogastric junction and the apex of the hiatus was equal to or shorter than 1.5 cm in 68 (37.7%) patients; at the second measurement (after full mediastinal isolation), the measurement of the distance was still shorter than 1.5 cm in 34 (18.8%) patients and between 1.5 and 2.5 cm in 24 (13.4%) patients. The median length of the mediastinal esophageal dissection was 6 cm (range 1–12 cm). An esophageal lengthening procedure was performed in 26 (14.4%) patients. The duration of symptoms (P = .047), the General Health domain of the SF-36 questionnaire (P = .001), and an x-ray barium swallow (P = .000) are predictive factors for a "true" short esophagus.

Conclusions: True short esophagus is present in about 20% of patients undergoing routine antireflux surgery. Radiology, severity, and duration of symptoms are predictors of true foreshortening.

Abbreviations and Acronyms CRF = case report form; EG = esophagogastric; GERD = gastroesophageal reflux disease


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